If you have a baby boy, you'll need to decide whether to have him circumcised. Consider the benefits and drawbacks [and the ethics].

[Advice like this always starts by considering circumcision, rather than the whole, perfect intact baby, why he has a foreskin, and whether it should just be left alone. A brochure exists that starts there.]

Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common in the United States, but is it right for your son? Here's help making an informed decision.

Opinions are mixed
For some parents, circumcision is a religious ritual. It can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, the procedure seems unnecessary [harmful, unethical] or disfiguring. [Notice the wishywashy "seems" for the negatives.]

The American Academy of Pediatrics (AAP) says the benefits aren't strong enough to recommend routine circumcision for all male newborns. The AAP leaves the decision up to parents — and supports use of pain relief for infants who have the procedure.

The benefitsCircumcision may have health benefits, including:

Easier hygiene. Circumcision makes it easy to wash the penis — although it's simple to clean an uncircumcised penis, too.

Decreased risk of urinary tract infections. The risk of urinary tract infections in the first year is low, but these infections may be up to 10 times as common in uncircumcised baby boys. Severe infections early in life can lead to kidney problems later on.

Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may narrow so much that it's difficult or impossible to retract. This can also lead to inflammation of the head of the penis. [but many men have no problem with it.]

Decreased risk of penile cancer. Although cancer of the penis is very rare, it's less common in circumcised men.

Decreased risk of sexually transmitted diseases. Safe sexual practices remain essential, but circumcised men may have a slightly lower risk of certain sexually transmitted diseases — including HIV, the virus that causes AIDS, and human papillomavirus (HPV), which causes genital warts. Some strains of HPV also cause cervical cancer.

The drawbacksCircumcision also has drawbacks, including:

Surgical risks. Excessive bleeding [which can result in death] and infection [which can result in death] are uncommon, but possible. The foreskin may be cut too short or too long or fail to heal properly. If the remaining foreskin reattaches to the end of the penis, minor surgery may be needed to correct it [leaving a scar on his glans].

Pain. Circumcision hurts. Local anesthesia can block nerve sensations during the procedure [but not afterwards. Urine on the wound stings for days afterwards].

Permanence. After the procedure, it may be impossible to re-create the appearance of an uncircumcised penis. [Actually, non-surgical restoration is quite good at re-creating the appearance, but not the function.]

Expense. Some insurance companies don't cover the cost of circumcision.

[Losses. Circumcision removes thousands of sensory nerves (and intact men have no problem handling the "extra" sensitivity, because it is the norm for them). Many men enjoy the unique rolling action of the foreskin itself.]

Other considerationsCircumcision shouldn't be done when a baby's urethral opening is in an abnormal position on the side or base of the penis. This condition is treated surgically and may [may not be discovered until the circumcision is underway, It may] require the foreskin for repair. Circumcision may not be an option in an infant with ambiguous genitalia or a family history of hemophilia.

Circumcision doesn't affect fertility. Whether the procedure enhances or detracts from sexual pleasure for men or their partners remains unknown [but there is ample anecdotal evidence that it detracts, and it is only common sense that it would. Whatever, isn't it foolhardy to keep on doing it without knowing?]

The procedure

CLICK TO ENLARGE

Penis before and aftercircumcision

Circumcision is often done in the hospital nursery. It may be done in an outpatient setting as well.

Your son will [be forced to] lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed [or rather, cut off {with a clamp} or allowed to die and drop off {with a plastic ring}]. Afterward, the penis will be covered with an ointment, such as petroleum jelly, and wrapped loosely with gauze.

The entire procedure takes about 15 minutes [...but the pain lasts for weeks].

Circumcision care[- So, contrary to popular opinion, a circumcised penis is not maintenance-free]It will take about seven to 10 days for the penis to heal. The tip of the penis may seem [no, it will be] raw at first, and you may notice a yellowish mucus or crust. A small amount of bleeding also is common the first day or two.

It's OK to wash the penis as it's healing. Change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. If there's a plastic ring instead of a bandage, it will [or rather, it should] drop off on its own — usually within a week.

There's persistent bleeding or redness around the tip of the penis [and modern gel-filled diapers can conceal the extent of bleeding].

The tip of the penis is swollen.

You suspect an infection — there's foul-smelling drainage from the tip of the penis, or crusted sores fill with fluid.

[Intact penis care

Leave the foreskin alone.

Wash the outside of the penis as you do the rest of his body

Do not allow a doctor, nurse or anyone else to retract your son's foreskin.]

Mar 3, 2006

Adult circumcision: Does it increase sexual pleasure?

Q. Is it true that circumcision increases sexual pleasure?
No name given/ New Jersey

A.. Circumcision is a surgical procedure that involves removing the skin (foreskin) covering the head of the penis. There is much debate about whether circumcision enhances or diminishes sexual pleasure in adult males. Some experts believe that circumcision reduces sensitivity of the tip of the penis and, as a result, decreases sexual pleasure. [And it should be perfectly obvious that it removes all sensation from the foreskin itself. Writers of this kind of information, usually circumcised themselves, have a big blind spot about this loss.] Others believe [usually following the biased, prejudged claims ofMasters & Johnson] it has no effect on sexual sensation or satisfaction. [So the short answer is "No". Those who claim it increases pleasure generally had sexual reasons for being circumcised, or a condition that made sexual performance sub-optimal. In general, those adults who were circumcised for non-sexual medical reasons have found the sexual effects to be negative.]